TOPLINE 

Patients with A1c levels above guideline goals had higher rates of decreases and increases in medications, whereas those with A1c levels below goals had similar deintensification but less intensification compared with those with A1c levels at goal.

METHODOLOGY

• Researchers analyzed electronic health record data of 89,987 older adults with type 2 diabetes (mean age, 71.6 years; 50.5% men) who were on at least one medication for diabetes and receiving care at the Cleveland Clinic from 2019 to 2023. 
• Patients were classified as having poor health (one or more terminal conditions), intermediate health (three or more chronic conditions), or good health (neither type of condition). 
• A1c levels in each year were categorized as at goal (37.8% of patients), below goal (noted in 48.4%), or above goal (noted in 13.8%).  
• Primary outcomes were the increase or decrease in diabetes drugs or dose of noninsulin drugs within 3 months after or before the first A1c measurement. 

TAKEAWAY

• In all, 32.8% of patients with A1c levels above the guideline goal experienced medication intensification compared with 16.1% of those with A1c levels at the guideline goal in 2023, and decreases in drugs occurred in 20.3% vs 16.3%, respectively. 
• Rates of intensification remained constant over the study period, but deintensification increased (from 14.6% to 20.3%; P < .001). 
• In 2023, patients with A1c levels below goal had a similar prevalence of deintensification to those with A1c levels at goal and lower rates of intensification (7.7% vs 16.1%; P < .001), respectively. 

IN PRACTICE 

“This study found most older adults with [type 2 diabetes] and [A1c] levels not at the recommended goal did not have their medications adjusted. Future efforts should focus on improving adherence to guideline recommendations and leveraging safer medication options,” the authors wrote.

SOURCE 

The study was led by Phuc Le, PhD, MPH, of the Center for Value-Based Care Research in the Primary Care Institute at the Cleveland Clinic in Cleveland. It was published online on August 10, 2026, as a research letter in JAMA Internal Medicine.

LIMITATIONS 

Changes in insulin doses could not be evaluated. The analysis only used the first A1c measurement in a year to determine glycemic status and did not include information on daily activities. 

DISCLOSURES 

No specific funding was reported. Various authors disclosed receiving grants and personal fees from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, and the Blue Cross Blue Shield Association, among others. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.